三种内固定系统治疗股骨转子间骨折的疗效比较

The efficacy of three types of internal fixation for intertrochanteric fractures

目的 比较分析三种内固定系统治疗股骨转子间骨折的临床效果.方法 对68例股骨转子间骨折病例进行对照比较,根据Evans分型,并结合患者的年龄、骨折粉碎程度和骨折的部位,将68例患者随机分为A、B、C三组,每组采用不同的内固定方法进行治疗,A组30例（Ⅰ型、Ⅱ型25例＋Ⅲ型、Ⅳ型5例）采用DHS内固定治疗,B组23例（Ⅰ型、Ⅱ型17例＋Ⅲ型、Ⅳ型6例）采用DCS内固定治疗、C组15例（均为Ⅲ型、Ⅳ型骨折）采用PFN治疗,术后评价三种内固定治疗方法在治疗股骨转子间骨折的优劣.结果 68例患者均获得随访,随访时间为8～37个月,平均19个月,全部骨折性愈合.根据Parker髋部骨折疗效标准：优52例,良8例,可6例,差2例,总优良率为91.18%.结论 DHS、DCS适用于稳定的Ⅰ型、Ⅱ型及部分Ⅲ型股骨转子间骨折,DCS更适于股骨粗隆下或逆粗隆骨折,而PFN适用于股骨转子间各种类型骨折,而对Ⅲ型、Ⅳ型不稳定型骨折优势明显.

Objective To compare the efficacy of three types of internal fixation for intertrochan-teric fractures. Methods 68 cases of intertrochanteric fracture were compared. According to Evans classification, combined with patient age and the extent and location of the fractures, 68 patients were randomly divided into groups A, B, and C, each group receiving different internal fixations. Group A of 30 patients （25 types Ⅰ and Ⅱ and 5 types Ⅲ and Ⅳ）, internal fixation with DHS; group B 23 （17 types Ⅰ and Ⅱ and 6 types Ⅲ and Ⅳ ）, fixation with DCS, group C （15 types Ⅲ and Ⅳ） treated with PFN. The advantages and disadvan-tages of the three procedures were assessed.Results 68 patients were followed up for 8 to 37 months, an average of 19 months and all fractures healed. According to the standard of Parker hip fracture, the efficacy was excellent in 52 patients, good in 8, fair in 6, and poor in 2; the total rate was 91.18%. Conclusions DHS and DCS are ideal for stable types Ⅰ and Ⅱ , part of type Ⅲ, and some type of intertrochanteric fracture, DCS is more suitable for intertrochanteric femoral fractures, and intertrochanteric PFN is for all types of fractures,especially types Ⅲ and Ⅳ type unstable fractures.